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J Thorac Cardiovasc Surg 2007;133:346-351
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Management of pleural space infections: A population-based analysis

^a Division of General Surgery, Department of Surgery, University of Washington, Seattle, Wash
^b Division of Cardiothoracic Surgery, Department of Surgery, Veterans Affairs Puget Sound Health Care System, Seattle, Wash
^c Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash
^d Division of General Surgery, Departments of Surgery and Health Services, University of Washington, Seattle, Wash.

Read at the Thirty-second Annual Meeting of the Western Thoracic Surgical Association, Sun Valley, Idaho, June 21-24, 2006.

Received for publication June 16, 2006; revisions received August 28, 2006; accepted for publication September 29, 2006.

^_* Address for reprints: David R. Flum, MD, Division of General Surgery, University of Washington, 1959 NE Pacific, Box 356410, Seattle, WA 98195-6310. (Email: daveflum{at}u.washington.edu).

OBJECTIVE: Management options for pleural space infections have changed over the last 2 decades. This study evaluated trends over time in the incidence of disease and use of different management strategies and their associated outcomes.

METHODS: A retrospective study was performed by using a statewide administrative database of all hospitalizations for pleural space infections between 1987 and 2004.

RESULTS: Four thousand four hundred twenty-four patients (age, 57.1 ± 18.6 years; 67% male; comorbidity index, 1.1 ± 1.9) were hospitalized with pleural space infections. The incidence rate increased 2.8% per year (95% confidence interval, 2.2%-3.4%; P < .001). Overall, 51.6% of patients underwent an operation, and the proportion increased from 42.4% in 1987 to 58.4% in 2004 (P < .001). The risk of death within 30 days was less for patients undergoing operations compared with that for patients not undergoing operations (5.4% vs 16.6%, P < .001); however, patients undergoing operations were younger (52.9 ± 17.6 years vs 61.5 ± 18.6 years, P < .001) and had a lower comorbidity index (0.8 ± 1.6 vs 1.4 ± 2.1, P < .001). After adjusting for age, sex, comorbidity index, and insurance status, patients undergoing operative therapy had a 58% lower risk of death (odds ratio, 0.42; 95% confidence interval, 0.32-0.56; P < .001) than those undergoing nonoperative management.

CONCLUSIONS: The incidence of pleural space infections and the proportion of patients undergoing operative management have increased over time. Patients undergoing operations were younger and had less comorbid illness than those not undergoing operations but had a much lower risk of early death, even after adjusting for these factors.

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